Pub Date : 2024-10-19DOI: 10.1016/j.ancard.2024.101828
S. Aroua , M. Boukheloua
<div><h3>Introduction</h3><div>La maladie de Fabry est souvent révélée entre la troisième et la quatrième décennie par un accident vasculaire cérébral (AVC) ou une insuffisance rénale aigue (IRA), constituant les circonstances de découverte les plus fréquentes de cette pathologie d’évolution insidieuse. Une fois le diagnostic posé, une enquête familiale doit être menée en vue d'une prise en charge adéquate avec recours aux thérapies spécifiques, notamment l'enzymothérapie substitutive afin de prévenir la défaillance irréversible des organes nobles qui marque le tournant évolutif de cette maladie et assombrit le pronostic.</div></div><div><h3>Description du cas</h3><div>Nous avons diagnostiqué une maladie de Fabry chez un patient de 38 ans à l'occasion de l'apparition d'une dyspnée d'aggravation progressive et d’œdèmes bilatéraux des membres inférieurs révélant une insuffisance rénale terminale, au stade de dialyse. La maladie de Fabry a été confirmée par l’étude génétique (figure 1). Un dépistage familial a été réalisé, en commençant par le frère cadet, âgé de 30 ans, puisqu'il s'agit justement de l’âge propice de découverte de la maladie et de l'instauration de la thérapeutique.</div><div>La maladie de Fabry a été diagnostiquée chez ce frère cadet, par un dosage enzymatique retrouvant un taux d'alpha galactosidase effondrée à 0.1 µmol/L/h (figure 2), bien qu'il soit asymptomatique et avec un examen physique sans particularité. Sur le plan paraclinique, l'ECG de surface de ce patient (figure 3) objectivait une HVG électrique, l’échocardiographie transthoracique confirmait une HVG type 3 de Maron sans gradient obstructif significatif (figure 4). Le Holter ECG des 48 H n'a pas retrouvé pas d'anomalie. Par ailleurs, les évaluations néphrologique, respiratoire, neuropsychologique, ophtalmologique et ORL étaient sans anomalies.</div></div><div><h3>Discussion</h3><div>Nous avons présenté un cas de maladie de Fabry découverte au stade précoce, chez un patient asymptomatique, dans le cadre d'un dépistage familial. Cette maladie génétique est liée au chromosome X, où l'anomalie du gène <em>GLA</em> est à l'origine d'un déficit de l'activité enzymatique lysosomale « l'alpha-galactosidase A» et d'une accumulation pathogène des sphingolipides « Gb3 et lyso-Gb3 » et des substrats enzymatiques au niveau des différents organes. Cette accumulation est à l'origine de l'expression progressive de cette maladie à partir de la troisième décennie. Il faut mettre l'accent sur l'intérêt du dépistage familial car le traitement spécifique précoce trouve tout son intérêt, considéré d'ailleurs comme la pierre angulaire qui marque le tournant évolutif de la maladie (1,2).</div></div><div><h3>Conclusion</h3><div>Un AVC, une IRA ainsi qu'une cardiomyopathie hypertrophique d'allure primitive ou certains signes aspécifiques avec un examen clinique équivoque chez un jeune aux alentours de la troisième décennie doivent nous orienter vers la maladie de Fabry. Lorsqu'elle est confir
{"title":"Intérêt du dépistage précoce de la maladie de Fabry","authors":"S. Aroua , M. Boukheloua","doi":"10.1016/j.ancard.2024.101828","DOIUrl":"10.1016/j.ancard.2024.101828","url":null,"abstract":"<div><h3>Introduction</h3><div>La maladie de Fabry est souvent révélée entre la troisième et la quatrième décennie par un accident vasculaire cérébral (AVC) ou une insuffisance rénale aigue (IRA), constituant les circonstances de découverte les plus fréquentes de cette pathologie d’évolution insidieuse. Une fois le diagnostic posé, une enquête familiale doit être menée en vue d'une prise en charge adéquate avec recours aux thérapies spécifiques, notamment l'enzymothérapie substitutive afin de prévenir la défaillance irréversible des organes nobles qui marque le tournant évolutif de cette maladie et assombrit le pronostic.</div></div><div><h3>Description du cas</h3><div>Nous avons diagnostiqué une maladie de Fabry chez un patient de 38 ans à l'occasion de l'apparition d'une dyspnée d'aggravation progressive et d’œdèmes bilatéraux des membres inférieurs révélant une insuffisance rénale terminale, au stade de dialyse. La maladie de Fabry a été confirmée par l’étude génétique (figure 1). Un dépistage familial a été réalisé, en commençant par le frère cadet, âgé de 30 ans, puisqu'il s'agit justement de l’âge propice de découverte de la maladie et de l'instauration de la thérapeutique.</div><div>La maladie de Fabry a été diagnostiquée chez ce frère cadet, par un dosage enzymatique retrouvant un taux d'alpha galactosidase effondrée à 0.1 µmol/L/h (figure 2), bien qu'il soit asymptomatique et avec un examen physique sans particularité. Sur le plan paraclinique, l'ECG de surface de ce patient (figure 3) objectivait une HVG électrique, l’échocardiographie transthoracique confirmait une HVG type 3 de Maron sans gradient obstructif significatif (figure 4). Le Holter ECG des 48 H n'a pas retrouvé pas d'anomalie. Par ailleurs, les évaluations néphrologique, respiratoire, neuropsychologique, ophtalmologique et ORL étaient sans anomalies.</div></div><div><h3>Discussion</h3><div>Nous avons présenté un cas de maladie de Fabry découverte au stade précoce, chez un patient asymptomatique, dans le cadre d'un dépistage familial. Cette maladie génétique est liée au chromosome X, où l'anomalie du gène <em>GLA</em> est à l'origine d'un déficit de l'activité enzymatique lysosomale « l'alpha-galactosidase A» et d'une accumulation pathogène des sphingolipides « Gb3 et lyso-Gb3 » et des substrats enzymatiques au niveau des différents organes. Cette accumulation est à l'origine de l'expression progressive de cette maladie à partir de la troisième décennie. Il faut mettre l'accent sur l'intérêt du dépistage familial car le traitement spécifique précoce trouve tout son intérêt, considéré d'ailleurs comme la pierre angulaire qui marque le tournant évolutif de la maladie (1,2).</div></div><div><h3>Conclusion</h3><div>Un AVC, une IRA ainsi qu'une cardiomyopathie hypertrophique d'allure primitive ou certains signes aspécifiques avec un examen clinique équivoque chez un jeune aux alentours de la troisième décennie doivent nous orienter vers la maladie de Fabry. Lorsqu'elle est confir","PeriodicalId":7899,"journal":{"name":"Annales de cardiologie et d'angeiologie","volume":"73 5","pages":"Article 101828"},"PeriodicalIF":0.3,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-19DOI: 10.1016/j.ancard.2024.101824
M. Ramifehiarivo , V. Rakotonirinarisoa , LR Ramiandrisoa , DNAH Rabearimanana , RH Rakotoarisoa , T. Rajaobelison , AJC Rakotoarisoa , N. Rabearivony
Introduction
La pancardite aigue à Staphylococcus aureus est une maladie grave avec une morbi-mortalité importante qui nécessite un diagnostic et une prise en charge rapide. Elle est souvent à bas bruits et d’évolutions aiguë chez les patients immunodéprimés.
Présentation du cas
Nous présentons le cas d'un homme diabétique de 40 ans, chez qui a été diagnostiquée une endomyopéricardite aigue à Staphylococcus aureus sur valve mitrale native, révélée par une tamponnade purulente (figure 1). L’évolution a été marquée par l'apparition aigue à l’échographie trans thoracique d'une végétation avec présence d'une fuite au dépend de la valve mitrale et d'une atteinte myocardique (figure2). Le patient a été traité par un drainage chirurgical et une antibiothérapie adaptée au long cours, mais n'a pas pu bénéficier d'une chirurgie sur sa valve mitrale. Son état clinique et biologique s'est amélioré progressivement. Une échographie de contrôle à 1 mois n'a pas retrouvé la végétation de la valve mitrale, ni de majoration de la fuite (figure3).
Discussion
Le diabète est un terrain favorisant les infections, il peut être méconnu ou révélé par des complications infectieuses (1); comme notre cas ici présent, où l'infection péricardique primaire a été une complication du diabète avec comme porte d'entrée une infection ORL.
Ici, la découverte d'une infection a Staphylococcus aureus au niveau du péricarde peut engendrer sur une courte période une atteinte endomyocardique complétant le tableau de pancardite. Ce germe est le plus souvent identifié en cas d'endocardite d’évolution suraiguë (2).
L’échocardiographie trans-thoracique a été la pièce maitresse du diagnostic chez notre patient. Elle est rapide et non invasive et présente une excellente spécificité pour les végétations (98%) (3).
Conclusion
: Devant une infection à Staphylocoque aureus chez les immunodéprimés, la recherche d'atteinte endomyopéricardique doit être évoqué vu la virulence du germe; la pancardite est une pathologie encore très présente dans les pays en développement mais sous diagnostiquée et la prise en charge se limite au traitement médicamenteux en absence de plateau technique.
{"title":"Pancardite staphylococcique d’évolution miraculeuse : à propos d'un cas à Madagascar","authors":"M. Ramifehiarivo , V. Rakotonirinarisoa , LR Ramiandrisoa , DNAH Rabearimanana , RH Rakotoarisoa , T. Rajaobelison , AJC Rakotoarisoa , N. Rabearivony","doi":"10.1016/j.ancard.2024.101824","DOIUrl":"10.1016/j.ancard.2024.101824","url":null,"abstract":"<div><h3>Introduction</h3><div>La pancardite aigue à <em>Staphylococcus aureus</em> est une maladie grave avec une morbi-mortalité importante qui nécessite un diagnostic et une prise en charge rapide. Elle est souvent à bas bruits et d’évolutions aiguë chez les patients immunodéprimés.</div></div><div><h3>Présentation du cas</h3><div>Nous présentons le cas d'un homme diabétique de 40 ans, chez qui a été diagnostiquée une endomyopéricardite aigue à <em>Staphylococcus aureus</em> sur valve mitrale native, révélée par une tamponnade purulente (figure 1). L’évolution a été marquée par l'apparition aigue à l’échographie trans thoracique d'une végétation avec présence d'une fuite au dépend de la valve mitrale et d'une atteinte myocardique (figure2). Le patient a été traité par un drainage chirurgical et une antibiothérapie adaptée au long cours, mais n'a pas pu bénéficier d'une chirurgie sur sa valve mitrale. Son état clinique et biologique s'est amélioré progressivement. Une échographie de contrôle à 1 mois n'a pas retrouvé la végétation de la valve mitrale, ni de majoration de la fuite (figure3).</div></div><div><h3>Discussion</h3><div>Le diabète est un terrain favorisant les infections, il peut être méconnu ou révélé par des complications infectieuses (1); comme notre cas ici présent, où l'infection péricardique primaire a été une complication du diabète avec comme porte d'entrée une infection ORL.</div><div>Ici, la découverte d'une infection a <em>Staphylococcus aureus</em> au niveau du péricarde peut engendrer sur une courte période une atteinte endomyocardique complétant le tableau de pancardite. Ce germe est le plus souvent identifié en cas d'endocardite d’évolution suraiguë (2).</div><div>L’échocardiographie trans-thoracique a été la pièce maitresse du diagnostic chez notre patient. Elle est rapide et non invasive et présente une excellente spécificité pour les végétations (98%) (3).</div></div><div><h3>Conclusion</h3><div>: Devant une infection à <em>Staphylocoque aureus</em> chez les immunodéprimés, la recherche d'atteinte endomyopéricardique doit être évoqué vu la virulence du germe; la pancardite est une pathologie encore très présente dans les pays en développement mais sous diagnostiquée et la prise en charge se limite au traitement médicamenteux en absence de plateau technique.</div></div>","PeriodicalId":7899,"journal":{"name":"Annales de cardiologie et d'angeiologie","volume":"73 5","pages":"Article 101824"},"PeriodicalIF":0.3,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-19DOI: 10.1016/j.ancard.2024.101821
M. Yile, M. Benali, H. Bendoudouch, M. Benabdellah, J. Tahiri, A. Zegwagh, L. Hara, A. Ech-chenbouli, B. El Boussaadani, Z. Raissouni
Introduction
Electrical cardioversion is a widely used technique to resolve tachydysrhythmias such as atrial fibrillation. This procedure is easy to perform with a high success rate. Nevertheless, it is crucial to closely monitor patients subjected to cardioversion to identify any potentially life-threatening complications.
Case Presentation
We present here the case of a 63-year-old male with a history of hypertension, dilated cardiomyopathy, and ischemic heart disease. He came to the emergency department due to a sudden onset of rapid heartbeat and difficulty breathing. Upon physical examination, the patient appeared to have dyspnea, tachycardia (155 beats/min), low blood pressure (60/30mmHg), swelling in his lower limbs, and a swollen abdomen due to an accumulation of fluid in the abdominal cavity, without any signs of pulmonary edema. An electrocardiogram showed atrial fibrillation. Since the patient could not tolerate the arrhythmia, cardioversion was performed, and the patient successfully converted to normal sinus rhythm. However, shortly after the procedure, the patient's dyspnea worsened, with bilateral crackling sound on the base of his lung at auscultation. These signs indicated the presence of pulmonary edema. The patient improved shortly after receiving dialysis and diuretic therapy.
Conclusion
Electrical cardioversion plays a crucial role in the management of atrial fibrillation, demonstrating a high effectiveness in treating patients with recent onset of atrial fibrillation. While complications of cardioversion are rare, it is vital to thoroughly evaluate the patient's condition afterward and maintain a vigilant clinical monitoring post-procedure to ensure appropriate and effective rhythm control therapy (fig. 1 and 2).
{"title":"A Rare Complication: Post-Cardioversion Pulmonary Edema","authors":"M. Yile, M. Benali, H. Bendoudouch, M. Benabdellah, J. Tahiri, A. Zegwagh, L. Hara, A. Ech-chenbouli, B. El Boussaadani, Z. Raissouni","doi":"10.1016/j.ancard.2024.101821","DOIUrl":"10.1016/j.ancard.2024.101821","url":null,"abstract":"<div><h3>Introduction</h3><div>Electrical cardioversion is a widely used technique to resolve tachydysrhythmias such as atrial fibrillation. This procedure is easy to perform with a high success rate. Nevertheless, it is crucial to closely monitor patients subjected to cardioversion to identify any potentially life-threatening complications.</div></div><div><h3>Case Presentation</h3><div>We present here the case of a 63-year-old male with a history of hypertension, dilated cardiomyopathy, and ischemic heart disease. He came to the emergency department due to a sudden onset of rapid heartbeat and difficulty breathing. Upon physical examination, the patient appeared to have dyspnea, tachycardia (155 beats/min), low blood pressure (60/30mmHg), swelling in his lower limbs, and a swollen abdomen due to an accumulation of fluid in the abdominal cavity, without any signs of pulmonary edema. An electrocardiogram showed atrial fibrillation. Since the patient could not tolerate the arrhythmia, cardioversion was performed, and the patient successfully converted to normal sinus rhythm. However, shortly after the procedure, the patient's dyspnea worsened, with bilateral crackling sound on the base of his lung at auscultation. These signs indicated the presence of pulmonary edema. The patient improved shortly after receiving dialysis and diuretic therapy.</div></div><div><h3>Conclusion</h3><div>Electrical cardioversion plays a crucial role in the management of atrial fibrillation, demonstrating a high effectiveness in treating patients with recent onset of atrial fibrillation. While complications of cardioversion are rare, it is vital to thoroughly evaluate the patient's condition afterward and maintain a vigilant clinical monitoring post-procedure to ensure appropriate and effective rhythm control therapy (fig. 1 and 2).</div></div>","PeriodicalId":7899,"journal":{"name":"Annales de cardiologie et d'angeiologie","volume":"73 5","pages":"Article 101821"},"PeriodicalIF":0.3,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-19DOI: 10.1016/j.ancard.2024.101829
Géraldine Gibault-Genty, Jean-Louis Georges
{"title":"Osons la cardiologie interventionnelle ambulatoire !","authors":"Géraldine Gibault-Genty, Jean-Louis Georges","doi":"10.1016/j.ancard.2024.101829","DOIUrl":"10.1016/j.ancard.2024.101829","url":null,"abstract":"","PeriodicalId":7899,"journal":{"name":"Annales de cardiologie et d'angeiologie","volume":"73 5","pages":"Article 101829"},"PeriodicalIF":0.3,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-19DOI: 10.1016/S0003-3928(24)00112-4
{"title":"Sommaire","authors":"","doi":"10.1016/S0003-3928(24)00112-4","DOIUrl":"10.1016/S0003-3928(24)00112-4","url":null,"abstract":"","PeriodicalId":7899,"journal":{"name":"Annales de cardiologie et d'angeiologie","volume":"73 5","pages":"Article 101834"},"PeriodicalIF":0.3,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-18DOI: 10.1016/j.ancard.2024.101804
M. Rahmi, F. Merzouk, A. El Ouarradi, R. Habbal
Background
Papillary fibroelastoma is a rare benign cardiac tumor, but capable of causing severe ischemic manifestations and exposing the patient to embolic complications and sudden death which requires urgent surgical resection.
Case presentation
We report the case of a 34-year-old man presenting with ischemic stroke. Cardiac ultrasonography revealed a pedunculated tumor inserted on the basal interventricular septum, mobile in the LV hunting chamber in the vicinity of the large mitral valve. Surgical excision was performed without any operative or post-operative difficulties. Histological examination confirmed the diagnosis of papillary fibroelastoma. The clinical course was favorable, with no ischemic recurrence.
Conclusion
We recall through this observation the high emboligenic potential of this tumor, whose surgical treatment prevents cerebral embolic recurrence.
{"title":"Un cas rare de fibroélastome papillaire révélé par un accident vasculaire cérébral ischémique (à propos d'un cas)","authors":"M. Rahmi, F. Merzouk, A. El Ouarradi, R. Habbal","doi":"10.1016/j.ancard.2024.101804","DOIUrl":"10.1016/j.ancard.2024.101804","url":null,"abstract":"<div><h3>Background</h3><div>Papillary fibroelastoma is a rare benign cardiac tumor, but capable of causing severe ischemic manifestations and exposing the patient to embolic complications and sudden death which requires urgent surgical resection.</div></div><div><h3>Case presentation</h3><div>We report the case of a 34-year-old man presenting with ischemic stroke. Cardiac ultrasonography revealed a pedunculated tumor inserted on the basal interventricular septum, mobile in the LV hunting chamber in the vicinity of the large mitral valve. Surgical excision was performed without any operative or post-operative difficulties. Histological examination confirmed the diagnosis of papillary fibroelastoma. The clinical course was favorable, with no ischemic recurrence.</div></div><div><h3>Conclusion</h3><div>We recall through this observation the high emboligenic potential of this tumor, whose surgical treatment prevents cerebral embolic recurrence.</div></div>","PeriodicalId":7899,"journal":{"name":"Annales de cardiologie et d'angeiologie","volume":"73 6","pages":"Article 101804"},"PeriodicalIF":0.3,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-18DOI: 10.1016/j.ancard.2024.101803
I Coulibaly , JJ N'Djessan , A Adoubi , E Soya , MP Ncho-Mottoh , I Angoran , S Kouamé , G Tro , C Touré , B Kouamé , JB Anzouan-Kacou
Introduction
Atrial fibrillation is the most common cardiac rhythm disorder whose incidence with age and which is responsible for high morbidity and mortality.
Objective
Evaluate the thromboembolic risk of patients with atrial fibrillation and analyze the quality of the oral anticoagulation therapy at the Abidjan cardiology institute.
Methods
This was a multicenter, retrospective and prospective cross-sectional study, with descriptive and analytical aims in 332 patients followed for atrial fibrillation diagnosed on the electrocardiogram.
Results
Average age of 61 years (standard deviation = 16), with a female predominance with a sex ratio (M/F) of 0.93. The circumstances of discovery of atrial fibrillation were mainly palpitations (58.1%). Hypertension (57.8%). was the most frequently encountered comorbidity Underlying heart diseases were dominated by dilated cardiomyopathy (26.8%) and hypertensive heart disease (18.1%). The average CHA2DS2-VASc score was = 3.1 (standard deviation = 1.5) revealing a high level of thromboembolic risk (CHA2DS2-VASc score ≥2) in 76% of cases. The mean HAS-BLED score was =1.9 (SD =1.2).
VKA were the main antithrombotic therapy prescribed in our patients and appeared of poor quality with a TTR <65% in the great majority of patients (93,75%)
Conclusion
Atrial fibrillation is a condition responsible for the occurrence of thromboembolic complications when antithrombotic management is not correct. In this instance good oral anticoagulation is the best treatment to instaure. VKA are the most prescribed OAC in our context.
The evaluation of the quality of anticoagulation by vitamin K antagonist is essential by one of its most used indices is the time spent in the therapeutic zone (TTR).
{"title":"Prévention du risque thromboembolique de la fibrillation atriale dans le service de cardiologie d'Abidjan","authors":"I Coulibaly , JJ N'Djessan , A Adoubi , E Soya , MP Ncho-Mottoh , I Angoran , S Kouamé , G Tro , C Touré , B Kouamé , JB Anzouan-Kacou","doi":"10.1016/j.ancard.2024.101803","DOIUrl":"10.1016/j.ancard.2024.101803","url":null,"abstract":"<div><h3>Introduction</h3><div>Atrial fibrillation is the most common cardiac rhythm disorder whose incidence with age and which is responsible for high morbidity and mortality.</div></div><div><h3>Objective</h3><div>Evaluate the thromboembolic risk of patients with atrial fibrillation and analyze the quality of the oral anticoagulation therapy at the Abidjan cardiology institute.</div></div><div><h3>Methods</h3><div>This was a multicenter, retrospective and prospective cross-sectional study, with descriptive and analytical aims in 332 patients followed for atrial fibrillation diagnosed on the electrocardiogram.</div></div><div><h3>Results</h3><div>Average age of 61 years (standard deviation = 16), with a female predominance with a sex ratio (M/F) of 0.93. The circumstances of discovery of atrial fibrillation were mainly palpitations (58.1%). Hypertension (57.8%). was the most frequently encountered comorbidity Underlying heart diseases were dominated by dilated cardiomyopathy (26.8%) and hypertensive heart disease (18.1%). The average CHA2DS2-VASc score was = 3.1 (standard deviation = 1.5) revealing a high level of thromboembolic risk (CHA2DS2-VASc score ≥2) in 76% of cases. The mean HAS-BLED score was =1.9 (SD =1.2).</div><div>VKA were the main antithrombotic therapy prescribed in our patients and appeared of poor quality with a TTR <65% in the great majority of patients (93,75%)</div></div><div><h3>Conclusion</h3><div>Atrial fibrillation is a condition responsible for the occurrence of thromboembolic complications when antithrombotic management is not correct. In this instance good oral anticoagulation is the best treatment to instaure. VKA are the most prescribed OAC in our context.</div><div>The evaluation of the quality of anticoagulation by vitamin K antagonist is essential by one of its most used indices is the time spent in the therapeutic zone (TTR).</div></div>","PeriodicalId":7899,"journal":{"name":"Annales de cardiologie et d'angeiologie","volume":"73 6","pages":"Article 101803"},"PeriodicalIF":0.3,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-04DOI: 10.1016/j.ancard.2024.101810
Radwane Hakim, Grégoire Rangé
Percutaneous coronary intervention (PCI) is the preferred method of revascularization for chronic coronary syndromes. Outpatient PCI has demonstrated, in addition to its reliability and safety, the comfort of patients and the reduction of costs that weigh on our healthcare systems. Nevertheless, it remains largely underutilized in France, with significant disparities between centers, particularly between private and public ones. This article provides an overview of outpatient PCI in France based on the France PCI registry and allows us to position ourselves in relation to our European neighbors.
{"title":"L'angioplastie coronaire ambulatoire en France : données du registre France PCI","authors":"Radwane Hakim, Grégoire Rangé","doi":"10.1016/j.ancard.2024.101810","DOIUrl":"10.1016/j.ancard.2024.101810","url":null,"abstract":"<div><div>Percutaneous coronary intervention (PCI) is the preferred method of revascularization for chronic coronary syndromes. Outpatient PCI has demonstrated, in addition to its reliability and safety, the comfort of patients and the reduction of costs that weigh on our healthcare systems. Nevertheless, it remains largely underutilized in France, with significant disparities between centers, particularly between private and public ones. This article provides an overview of outpatient PCI in France based on the France PCI registry and allows us to position ourselves in relation to our European neighbors.</div></div>","PeriodicalId":7899,"journal":{"name":"Annales de cardiologie et d'angeiologie","volume":"73 5","pages":"Article 101810"},"PeriodicalIF":0.3,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142379027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Same day discharge (SDD) diagnostic coronary angiography and percutaneous coronary interventions (PCIs) are increasingly performed, and indications extend to more complex procedures and more fragile patients. We report the evolution of SDD interventional cardiology activity in our centre since 2016, particularly before and after the COVID-19 pandemic. Secondarily, we analysed the feasibility and safety of SDD PCI.
Materials and methods
We analysed the number and percentage of SDD coronary angiograms and PCIs (elective or ad hoc), during 4 periods of 11 months each, from September 2016 to July 2024. Periods 1 and 2 took place before COVID-19, periods 3 and 4 after. We also compared the rate of complications and conversion to hospitalisation between periods 1-2 and 4.
Results
A total of 9587 procedures were analysed, including 1558 SDD procedures. The total number of SDD interventional cardiology procedures increased progressively over the 4 periods, from 146 SDD procedures (7.5%) in 2016–2017 to 620 (27.2%) in 2023–2024. This increase included both diagnostic coronary angiograms (respectively: 10.9%; 12.2%; 33.6% then 28.9%) and PCIs (respectively: 0.9%; 5.6%; 16.1% then 24.4%). In the immediate post-COVID-19 period, a significant increase, uncorrelated with the natural progression, was observed for SDD diagnostic coronary angiography and ad-hoc PCI. There were no deaths or serious complications, the rate of minor complications (1.1%) and conversion to conventional hospitalisation (4.5%) were low.
Conclusion
Provided a careful patient selection and rigorous organisation, SDD coronary angiography and PCI can safely be performed. The increase in the SDD interventional procedures, favoured by organisational (COVID-19) or economic constraints, need to be amplified.
{"title":"Coronarographie et angioplastie coronaire ambulatoire avant et après la pandémie de COVID-19 : expérience du centre hospitalier de Versailles","authors":"Taha Ettachfini , Géraldine Gibault-Genty , Elodie Blicq , Guillaume Godeau , Cheick-Hamala Fofana , Grégoire Lefèvre , Badreddine Ajlani , Bernard Livarek","doi":"10.1016/j.ancard.2024.101809","DOIUrl":"10.1016/j.ancard.2024.101809","url":null,"abstract":"<div><h3>Background</h3><div>Same day discharge (SDD) diagnostic coronary angiography and percutaneous coronary interventions (PCIs) are increasingly performed, and indications extend to more complex procedures and more fragile patients. We report the evolution of SDD interventional cardiology activity in our centre since 2016, particularly before and after the COVID-19 pandemic. Secondarily, we analysed the feasibility and safety of SDD PCI.</div></div><div><h3>Materials and methods</h3><div>We analysed the number and percentage of SDD coronary angiograms and PCIs (elective or <em>ad hoc</em>), during 4 periods of 11 months each, from September 2016 to July 2024. Periods 1 and 2 took place before COVID-19, periods 3 and 4 after. We also compared the rate of complications and conversion to hospitalisation between periods 1-2 and 4.</div></div><div><h3>Results</h3><div>A total of 9587 procedures were analysed, including 1558 SDD procedures. The total number of SDD interventional cardiology procedures increased progressively over the 4 periods, from 146 SDD procedures (7.5%) in 2016–2017 to 620 (27.2%) in 2023–2024. This increase included both diagnostic coronary angiograms (respectively: 10.9%; 12.2%; 33.6% then 28.9%) and PCIs (respectively: 0.9%; 5.6%; 16.1% then 24.4%). In the immediate post-COVID-19 period, a significant increase, uncorrelated with the natural progression, was observed for SDD diagnostic coronary angiography and ad-hoc PCI. There were no deaths or serious complications, the rate of minor complications (1.1%) and conversion to conventional hospitalisation (4.5%) were low.</div></div><div><h3>Conclusion</h3><div>Provided a careful patient selection and rigorous organisation, SDD coronary angiography and PCI can safely be performed. The increase in the SDD interventional procedures, favoured by organisational (COVID-19) or economic constraints, need to be amplified.</div></div>","PeriodicalId":7899,"journal":{"name":"Annales de cardiologie et d'angeiologie","volume":"73 5","pages":"Article 101809"},"PeriodicalIF":0.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-26DOI: 10.1016/j.ancard.2024.101799
A. Yesiloz , S. Sanchez , H. Mesrar , J. Chrusciel , M. Dacunka , F. Raoul , G. Simon , D. Metz , L. Chapoutot
Introduction
Acute Coronary Syndrome (ACS) are one of the main causes of mortality in France. Patients presenting with ACS are typically hospitalized in a specialized cardiology ward. The main objective of this study was to describe, characterize and evaluate the outcome of patients hospitalized for ACS in a generalist intensive care unit (rather than a cardiac care unit).
Methods
This was a retrospective study. Our population consisted of ACS patients admitted to an intensive care unit in a hospital center (Centre Hospitalier de Troyes) between 2012 and 2021. All patients admitted for ACS to the intensive care unit and who underwent coronary angiography were included.
Results
In 10 years, 104 patients, or 3.8% of ACS patients who underwent coronary angiography were admitted to intensive care. The majority were admitted after recovered cardiac arrest (72%) and were in cardiogenic shock (68%), accounting for a high in-hospital mortality (45.2%). In-hospital mortality was 45.2%. In multivariate analysis, the GRACE score was associated with in-hospital mortality (OR for each additional point = 1.024, 95% confidence interval 1.006–1.045, p = 0.01). Among the survivors, 88% had good neurological function when leaving the hospital.
Discussion
Mortality of ACS patients in intensive care was close to 50%. However, the neurological prognosis of the surviving patients was good. This population is rarely mentioned in the literature, and deserves to be evaluated by multicenter, prospective registries, with a view to improving management and prognosis.
{"title":"Les patients hospitalisés en réanimation pour un syndrome coronarien aigu de 2012 à 2021 : une étude rétrospective monocentrique","authors":"A. Yesiloz , S. Sanchez , H. Mesrar , J. Chrusciel , M. Dacunka , F. Raoul , G. Simon , D. Metz , L. Chapoutot","doi":"10.1016/j.ancard.2024.101799","DOIUrl":"10.1016/j.ancard.2024.101799","url":null,"abstract":"<div><h3>Introduction</h3><div>Acute Coronary Syndrome (ACS) are one of the main causes of mortality in France. Patients presenting with ACS are typically hospitalized in a specialized cardiology ward. The main objective of this study was to describe, characterize and evaluate the outcome of patients hospitalized for ACS in a generalist intensive care unit (rather than a cardiac care unit).</div></div><div><h3>Methods</h3><div>This was a retrospective study. Our population consisted of ACS patients admitted to an intensive care unit in a hospital center (Centre Hospitalier de Troyes) between 2012 and 2021. All patients admitted for ACS to the intensive care unit and who underwent coronary angiography were included.</div></div><div><h3>Results</h3><div>In 10 years, 104 patients, or 3.8% of ACS patients who underwent coronary angiography were admitted to intensive care. The majority were admitted after recovered cardiac arrest (72%) and were in cardiogenic shock (68%), accounting for a high in-hospital mortality (45.2%). In-hospital mortality was 45.2%. In multivariate analysis, the GRACE score was associated with in-hospital mortality (OR for each additional point = 1.024, 95% confidence interval 1.006–1.045, <em>p</em> = 0.01). Among the survivors, 88% had good neurological function when leaving the hospital.</div></div><div><h3>Discussion</h3><div>Mortality of ACS patients in intensive care was close to 50%. However, the neurological prognosis of the surviving patients was good. This population is rarely mentioned in the literature, and deserves to be evaluated by multicenter, prospective registries, with a view to improving management and prognosis.</div></div>","PeriodicalId":7899,"journal":{"name":"Annales de cardiologie et d'angeiologie","volume":"73 5","pages":"Article 101799"},"PeriodicalIF":0.3,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142322586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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